Wiki Past timely filing

[june616]

As I've mentioned in another post, I took over working the AR for a large family practice and it was very neglected so there is a lot to go through. Unfortunetly, there are A LOT of claims that are past timely filing. Some have already denied by the insurance and some were never sent out so I'm submitting them for denial.

I've checked the clearinghouse for claims transmission reports to appeal for some but many of them are not even showing in the clearinghouse. Once it reaches this point, I assume the only step to take is to adjust off the visit since I cannot show proof of timely filing without the transmitted claim report.

I want to make sure I cover all my bases and don't overlook anything else I can do to try to get these accepted. Any tips would be great. If not, I will adjust off knowing that I used all available resources and couldn't do anything else. Thank you so much!

 

[sheardmd]

It depends on the circumstances. Occasionally we have patients that do not give us their insurance information in a timely manner (we assumed that they were a self pay when they actually had insurance), and I have sent screen shots of the patients account notes showing that we were doing everything that we possibly could do to obtain the ins info and the patient did not respond, and I have had timely filing overturned in some of these instances.

 

[ollielooya]

Oh my, I understand the predicament your find yourself, as I work the AR process for several doctors as well. It's amazing how much money these physicians lose, and it seems a good billing staff are undervalued. Some of these claims you're working may fall into the ERISA camp, and if so, you may still be able to retrieve reimbursement even after the carrier declines for timely, but you'll have to get the patient involved and it does take extra work/and time. 1) the claim must qualify as an ERISA entity, 2) the patient must get involved, and that's something you obtain by an assignment of representative document (another story), and 3) you must obtain a copy of the summary plan description, (again, another story). I repeat, this takes time and study on your part. I've just entered into this arena, and by following proper protocol may be able to retrieve reimbursement from what originally was destined as write offs. Good luck, and I'll say again, it will take extra work on your part (have I said this enough?), but you'll shine as an AR Specialist. Will look good on your resume...